Intended for healthcare professionals


Treatment of heavy menstrual bleeding

BMJ 2010; 341 doi: (Published 17 August 2010) Cite this as: BMJ 2010;341:c3771
  1. Jane Clarke, research fellow
  1. 1Department of Obstetrics and Gynaecology , University of Auckland, Grafton, Auckland 1010, New Zealand
  1. j.clarke{at}

    Patients prefer hysterectomy, but less radical treatment should be considered initially

    Heavy menstrual bleeding (menorrhagia) is defined as blood loss greater than or equal to 80 ml per menstrual cycle.1 About 5% of women in the United Kingdom aged 30-49 years seek advice about heavy menstrual bleeding. A systematic review of four studies suggested a prevalence of excessive menstrual bleeding of between 4% and 9%.2

    In the linked systematic review (doi:10.1136/bmj.c3929), Middleton and colleagues assess the relative effectiveness of hysterectomy, endometrial destruction, and the levonorgestrel releasing intrauterine system (Mirena) system for the treatment of heavy menstrual bleeding.3

    First line treatment is generally medical and includes (in order of preference) the levonorgestrel intrauterine system, antifibrinolytic drugs (such as tranexamic acid), non-steroidal anti-inflammatory drugs (such as mefenamic acid and naproxen), progestogens (such as norethisterone and medroxyprogesterone acetate), the combined oral contraceptive pill, and danazol.4 Except in the case of short course progestogens, these medical treatments are effective in reducing menstrual blood loss.4

    Surgery may be …

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